Registered Nurses' Association of Ontario

Practice Recommendations



Level of Evidence


Recommendation 1.1: Assess the breastfeeding process, using validated and reliable tools, during pregnancy and at key stages of lactogenesis, including the following:

  • 1. During Stage I, (i.e., within the first 24 hours postpartum and prior to discharge from the childbirth setting), to support breastfeeding initiation.
  • 2. During the transition of Stage I to Stage II, (i.e., between days two to eight postpartum), to support the significant increase in breast milk volume.

3. During Stage II and Stage III, (i.e., from approximately day nine postpartum and onwards) to support the maintenance of breast milk production, as long as breastfeeding continues.










Recommendation 2.1: Facilitate skin-to-skin contact with the breastfeeding dyad immediately following childbirth or once clinically stable.


Recommendation 2.2: Support the early initiation of breastfeeding, within one hour of childbirth or once the breastfeeding dyad is clinically stable, through multi-component perinatal interventions including:

  • prenatal education and
  • immediate postpartum bedside assistance.


Recommendation 2.3: Support the breastfeeding dyad to achieve effective positioning, latch, and milk transfer. 


Recommendation 2.4: Support responsive cue-based breastfeeding through strategies such as:

  • education and promotion and
  • recognition of the needs of the breastfeeding person.

Ia, Ib

Recommendation 2.5: Teach hand expression to all breastfeeding persons prior to discharge from the childbirth setting.

Ia, V

Recommendation 2.6: Implement individualized breastfeeding self-efficacy interventions throughout the perinatal period to enhance breastfeeding confidence including:

  • one-on-one counseling prior to discharge from the childbirth setting and
  • follow-up post-discharge.

Ia, Ib

Recommendation 2.7: Provide individualized assistance to support or enhance breast milk production, where appropriate. 

Ia, V

Recommendation 2.8: Provide ongoing proactive breastfeeding support services to address the individualized needs of the breastfeeding dyad. 


Recommendation 2.9:  Facilitate informed decision-making regarding pacifier use. 


Recommendation 2.10: Provide breastfeeding education throughout the perinatal period and as long as breastfeeding continues:

  • across a variety of settings and
  • through diverse approaches, including those tailored to the needs of vulnerable populations.

    Recommendation 2.11:

    • Include family members, such as partners and grandmothers, in breastfeeding education and support


      Women and Children
      Breastfeeding Best Practice Guidelines for Nurses
      Practice Recommendations